Rules, as everyone knows, really are made to be broken. So all those naive folks who argue that giving doctors the right to kill people who are tired of living is fine because – wait for it – all you need to do is make sure you have the right rules in place to protect the innocent.

Yeah, right. That’s why a May 2010 study published in the Journal of the Canadian Medical Association found that 32 per cent – nearly one in three – of euthanasia deaths in the Flanders region of Belgium occurred without request or consent.

Indeed, another study published in the British Medical Journal in October 2010 found that 47 per cent – almost half – of euthanasia deaths in the same region of Belgium were simply not reported.

But how can this be? The law is clear. The rules are there for all to see. No can kill another person without their express consent and the approval of medical officials.

So don’t be fooled by those who say the rules will protect people. They won’t. Pick a law, any law, and you know darn well that the details often get lost in the shuffle. Sometimes it’s not such a big deal. But when we’re dealing with life or death, well, that is a big deal.

The issue of euthanasia, you likely know, is back into the public forum again despite Parliament having made it clear they don’t favor the concept. But that didn’t matter to an unelected and unaccountable British Columbia judge – whose wisdom clearly outshines the collective wisdom of Parliament – and who ruled in favor of 64-year-old Gloria Taylor’s request for physician-assisted suicide should she decide to end her battle with amyotrophic lateral sclerosis (ALS, or, as it’s widely known, Lou Gehrig’s disease.)

B.C. Supreme Court Justice Lynn Smith says Taylor, unlike anyone else in Canada, can legally get a doctor to help her kill herself. As for the rest of the country, she gave Parliament a year to come up with a new law which fits her definition of what is and what isn’t constitutional.

A few countries and a few U.S. states do allow physician-assisted suicide, but most of the civilized world, wisely, has stayed away from heading down that terribly slippery slope.

One of the realities of dying in modern times is that palliative care has become so good that there is no real reason to suffer undue pain. And it’s the fear of suffering painful deaths that prompts many people to argue for legalizing euthanasia.

But some of the places that use euthanasia have spent less time and effort developing better palliative care than everybody else. After all, why worry about keeping dying people comfortable when you can just stick a needle in them if their discomfort drives them to that extreme? To be sure, nobody would put it in those stark terms, but no matter how you define it, that’s the reality.

Then there’s the issue of the severly disabled who often aren’t mentally capable of making such a momentous decision and may have to rely on others to make it for them. And how about old Aunt Jane, whose been hanging on forever it seems, while the heirsto be stew about when the old lady will finally croak and they’ll get what’s coming to them. Sounds to harsh to be real? Hah. It happens now, even without legalizing the practice.

People do say that even as things stand doctors and family often decide to stop giving somebody medicine at a certain stage or, as they saying goes, to “pull the plug.” They confuse that with the active involvement of a doctor killing somebody who, without the intervention, wouldn’t be dying. It’s one thing to stop keeping people alive artificially via machine or drugs; it’s quite another to actually kill somebody who would otherwise be alive.

They’re not the same thing. One is reasonable; the other is essentially state-sanctioned murder. Well, not murder as we know it, since that’s a legal term and killing somebody legally wouldn’t be murder, would it? But under the current law it is murder and murder it should remain.

Advocates call it “dying with dignity,” as if dying naturally is by definition undignified.

The following letter was written by Dr. Howard Bright and published in the Chilliwack Progress on June 28, 2012. The article is titled: Down a Dangerous Path.

Based on unhappy experiences of dying loved ones, your columnist Margaret Evans is pleased with the recent Carter case ruling in favour of assisted suicide.(Rekindling the debate over doctor-assisted suicide, Chilliwack Progress, June 19.) I would like to offer a contrary view based on my experience as a family physician.

One person’s right can become another person’s obligation. When patients have the right to choose euthanasia, this sends an implicit message that some lives aren’t worth living.

Frail elderly, people with disabilities, and cancer patients can easily perceive that society doesn’t want them around, when they can instead choose to die “with dignity.” It is a short step from believing that they can choose dying to believing that they should choose dying.

We have come a long way in palliative care. I believe this is the greatest medical advance that I’ve observed during my career in medicine. Sure, there’s always room for improvement, but I’ve never heard a negative word about the care given to dying patients in our hospice. Dying in hospice, surrounded by loved ones, with good symptom control, can actually be a beautiful thing to witness. The disease causes death, not some medic with a lethal syringe.

The Canadian Medical Association has consistently voted against physician-assisted suicide. Why is this? Are physicians cruel sadists who want our patients to suffer? No.

We believe that palliative care is a better option. We never want patients to wonder whether their doctor will be trying to heal or trying to kill. We take an oath about this proscription against killing, and have done so ever since Hippocrates.

Sometimes individual rights are trumped by the common good. In the matter of physician-assisted suicide, this in one of those times.

"What you're actually doing in law . . . you have to create an exception under certain circumstances for murder.''

Mr Schadenberg said a euthanasia bill was defeated in the Canadian Parliament in 2010 but the debate led to a parliamentary committee looking at ways palliative care could be improved.

Meanwhile, Exit International director Dr Nitschke made public plans for a Tasmanian mobile medically assisted suicide clinic, modelled on the Dutch version.

He said the clinic model would be "readied for operation to coincide with the expected law change in Tasmania''.

The euthanasia issue is heating up in Tasmania. The Tasmanian Parliament has debated euthanasia on several occasions and over the years it has had two inquiries into the feasibility of legalizing euthanasia with both enquiries deciding against legalization.While in Tasmania, the big issue that the people shared with me was the crisis in healthcare that was occurring on the Island.The Tasmanian people were very concerned that the Greens and Labor leaders are pushing euthanasia again to achieve cost savings in healthcare. Whether this is true or not, it should be noted that when the pressure to cut the cost of healthcare is mixed with euthanasia, that the pressure to die will soon outweigh the will to live.

Today I had the opportunity to speak to members of the Tasmanian parliament about why it is not safe to legalize euthanasia or assisted suicide. In response to a question from a member of the Tasmanian parliament, I reminded them that Philip Nitschke had already promised to establish a euthanasia clinic in Tasmania, if they legalize euthanasia.

Later in the day I received this media release from Exit International announcing plans by Philip Nitschke, the founder of Exit International, to open a euthanasia clinic that would include mobile euthanasia teams, based upon a Dutch euthanasia clinic.

On March 1, a euthanasia clinic in the Netherlands launched six mobile euthanasia teams to provide an estimated 1000 euthanasia deaths to people who were either turned down by their doctor, or who are disabled and/or frail elderly people who lack mobility.

Plans for a Tasmanian mobile medically-assisted suicide clinic, modelled on the Dutch version, will be readied for operation to coincide with the expected law change in Tasmania.

Nitschke then stated in his media release:

Since announcing the establishment of a Hobart clinic in 2011 to take advantage of the expected changes to euthanasia laws, it has become clear that a mobile service made a great deal of sense.

The media release continued by explaining what he learned at the recent World Federation of Right to Die Societies Conference in Zurich:

"After looking at the Swiss model in Zurich, and talking with doctors from Holland, it is the sheer fact that I, as the doctor, can come to them rather than have the seriously ill attend a stand-alone clinic model."

He then concluded:

"Our Tasmanian plans echo the national home-visit clinic program I currently run under the Exit International umbrella. Only the Tasmanian model would allow me to also take that extra step and lawfully prescribe Nembutal."

After speaking to many members of the Tasmanian legislature, it is my hope that the Tasmanian legislature will kill the euthanasia bill and continue protecting the Tasmanian people from euthanasia, assisted suicide and Philip Nitschke.

Wednesday, June 27, 2012

Doctors attending the British Medical Association (BMA) annual conference in Bournemouth upheld their position opposing assisted suicide by rejecting a motion to move to a neutral position on assisted suicide.

Members of the BMA voted down proposals for the organisation to take a neutral stance.

Doctors speaking at the conference cautioned that a change in position would send the wrong message.

The Healthcare Professionals for Assisted Dying (HPAD) called for the BMA to move its position from opposition to "studied" neutrality.

HPAD's chairman Professor Raymond Tallis presented the motion at the conference, saying that assisted dying should be a matter for society as a whole and not just for the medical profession.

He also called on the union to adopt a neutral position on change in the law, saying the current system was "morally repugnant".

"Those of you who argue that palliative care can address all the problems of all patients are simply ignoring clinical reality," he said. "A reality in which some patients seeking an end to their terrible suffering resort to death from dehydration and starvation, botched suicides or dreadful journeys to die abroad.

"Neutrality is appropriate because the medical profession itself is divided.

"The BMA should adopt a position, not of opposition or indeed of support, but of studied neutrality towards a change of law to permit assisted dying for terminally ill, mentally competent adults."

In rebuttal, Dr Dai Samuel said: "We must question what as doctors we stand for. I simply stand for looking after my patients and providing high quality care.

"I do not consider the killing of patients - whatever the reason is - justified. That is murder and I cannot commit that offence."

BMA's outgoing chairman of council Dr Hamish Meldrum urged doctors not to take a neutral stance.

He said: "The first part of this motion says that this is a matter for society and not for the medical profession.

"The medical profession is not only part of society, but it would be members of the medical profession that would have to carry out the wishes of society were there to be a change in the law.

"On (the second part of the motion) it says the BMA should adopt a neutral position on a change in the law.

"I think adopting a neutral position is probably the worst of all options. Neutrality does tend to exclude us from the argument, an argument which would have a huge bearing on the working lives of doctors.

Peter Saunders

"I don't come to this from any strong religious view but I do come to these views from having worked as a doctors for 40 years - mostly in general practice - where I have always felt I have been able, in almost every occasion, to support my patients when they were dying without having to actively end their lives."

Spokesman Dr Peter Saunders said: "Majority medical opinion remains opposed to assisted dying and this vote is a victory for common sense.

"We hope that the BMA will now continue its valuable work in campaigning for high quality compassionate care for patients at the end of life."

The BMA has once again maintained a position against assisted suicide, even after the euthanasia created an organised lobby within the BMA. It is important that doctors refuse to change their ethics and refuse to kill their patients.

Tuesday, June 26, 2012

Nick McKim, the leader of the Greens in the Australian state of Tasmania has announced that he will be introducing a euthanasia bill that will be co-sponsored by Premier Lara Giddings, the leader of the Labor party.

A discussion paper outlining the pros and cons of different right-to-die laws from overseas is expected to be released within the next few weeks.

The feedback will inform a private members bill Premier Lara Giddings and Tasmanian Greens leader Nick McKim will introduce into state Parliament this year as co-sponsors.
Mr McKim said a draft discussion paper on the merits of voluntary euthanasia was being finalised.

''Rather than seeking a discussion on whether or not we should introduce voluntary euthanasia, it will be encouraging discussion around how it should be done,'' he said.
''We will then draft and table legislation that is appropriate for Tasmania, which gives it the best chance of passing the Parliament.''

Ms Giddings said the paper would consider the laws used overseas and suggest an appropriate model for Tasmania.

''Throughout our work on this matter we have acknowledged that legalising voluntary assisted dying is a serious step for any state to take on behalf of its citizens,'' she said.
''But we believe it is possible to carefully and sensitively improve end-of-life decision-making through a safe and regulated legal and medical framework.''

I will be in Hobart Tasmania on Thursday with Paul Russell, the leader of HOPE Australia. HOPE and EPC have announced to the media that there will be a press conference at 12 noon on the steps of the state Parliament in Hobart Tasmania.

I will explain how research in other jurisdictions confirms that it is not safe to legalize euthanasia and assisted suicide.

Assisted suicide should not be legal because older people are at great risk for abuse. In my experience as a licensed practical nurse working with older people in home care, I have come across many concerning situations.

I have seen firsthand a family fighting over the will of their parents while they are still alive.

I see that this greatly affects the way the parent feels as they grow older.

They feel as if the family wants them to die so they can have their money.

Some express the pain that they feel when they see loved ones discussing their money as if they have already passed away.

If assisted suicide was legal, some older people would feel the need to say yes - to die - because they are given the message that they are a burden to their family. Some of these older people can be easily convinced and put their trust fully in their caregivers and families.

If assisted suicide were legal, then some would really not make the decision, but let someone else make the decision for them. How is this right?

Especially if older people have money or real estate, our laws against assisted suicide are there to protect them.

Changing the law to allow assisted suicide would violate their right to be protected in this way.

In the past week I have received several comments from readers and followers of this blog.

A long time ago, I decided that I would not publish comments from people who decided to remain Anonymous. The reason I made this decision was that sometimes I have received hideous comments from people who were attacking others, or attacking me, without the person willing to put their name to their destructive comments.

I also receive some very good and instructive comments from people who are also remaining Anonymous.

Whether the comment is instructive or destructive, I simply will not publish an Anonymous comment.

Therefore if you want your comments posted on this blog, please leave your name with the comment.

“I want the legal right to die peacefully, at the time of my own choosing, in the embrace of my family and friends.”

Those are the words of Gloria Taylor, the 64-year-old woman at the centre of a landmark B.C. Supreme Court ruling that strikes down Canada’s prohibition against physician-assisted suicide (PAS).

What’s ironic about Taylor’s statement is if she gets her legal right to die at the time of her own choosing, evidence shows that the right of many others to continue living will be jeopardized. That is the unintended consequence and irony behind euthanasia and PAS: Some people get the right to choose how and when to die and others don’t have the right to choose anything — ever again — because they will be involuntarily killed by their physicians.

That is what the evidence stemming from years of PAS shows in countries like the Netherlands and Belgium.

On June 15, Justice Lynn Smith ruled that the prohibition against PAS violates two section of the Charter of Rights and Freedoms — the right to equality and the right to life, liberty and the security of the person.

Because Taylor suffers from ALS, also known as Lou Gehrig’s disease, Smith ruled that Taylor’s right to equality is violated since her disability would make it impossible for her to kill herself, which is the right of every other able bodied Canadian. Smith has given Parliament one year to rewrite the law, however, it’s more likely that her ruling will be appealed to the Supreme Court of Canada.

In her 286-page ruling, Smith refers to many comprehensive reports from the Netherlands and Belgium that clearly demonstrate that thousands of people have been killed without their consent by physicians, and yet she accepts the conclusion of pro-euthanasia experts that there is little evidence of a “slippery slope” or danger to society by turning the tables on the age-old rule against the premeditated killing of another human being.

When physician-assisted suicide became a common practice in Holland about 30 years ago, the guidelines were that only terminally ill elderly people in excruciating pain who were not depressed and repeatedly asked for euthanasia would be eligible for euthanasia.

“Now, people suffering from psychiatric illnesses, youth and even infants are killed by their physicians in the Netherlands,” said Schadenberg. “If that’s not a slippery slope, I don’t know what is.” Heck, if that’s not a slippery slope, then neither is Mount Everest.

Smith refers to a series of highly regarded reports colloquially named the Remmelink reports, after Prof. Jan Remmelink, attorney general of the High Council of the Netherlands. In his first report in 1990, it was determined that 1,031 hospital patients were killed without their consent or knowledge. Of those 1,031 people, 14 per cent were found to be fully competent, 72 per cent had never expressed that they wanted their lives ended, and in eight per cent of the cases, doctors carried out “involuntary euthanasia” even though they believed other options were still available.

Catch that? Mull over those numbers. They speak of horror. And don’t be fooled by the euphemisms. Involuntary euthanasia is a shifty way of saying premeditated murder.

As Smith points out in her ruling, “similar studies were conducted in 1995, 2001 and 2005. Data were collected in 2010, but the results have yet to be published,” she writes.

“All four studies revealed cases of LAWER in the Netherlands,” writes Smith, referring to the Dutch term that means physician-assisted suicide without request and consent.

“In absolute numbers, there were 1,000 in 1990; 900 in each of 1995 and 2001 and 550 in 2005.”

Get the picture? You can have rules that say you must be old, terminally ill and must have expressed a desire to be killed, and once you allow this to be an accepted practice, doctors might just decide to kill you off and experts are going to shrug it off as “not necessarily proof of a slippery slope.”

Please, I urge all readers to google Remmelink and also the Groningen Protocol, which are the rules surrounding when it’s OK to murder infants not born perfect — including ones suffering only from spina bifida. The Groningen Protocol states that a baby can be killed if it does not need medical treatment but is likely to suffer.

Likely to suffer? Doesn’t that include all of us? Who made these people God? Well, courts did. Legislatures did.

So call your MPs, call the Prime Minister’s Office. Tell them you want them to appeal this dangerous ruling.

Taylor said the following in a news conference this week: “To die screaming at the top of my lungs because the pain is so great that I can’t stand it is something I try not to think about.” It’s terrible what Taylor is going through and I feel deep compassion for her. That’s why, when you call the PM and your MPs, also tell them that you want a comprehensive plan to improve palliative care and end-of-life care in this country so Taylor’s last days can be pain free.

That won’t just make someone’s dying bearable, it just might save your life.

On Friday, June 15, Justice Lynn Smith in Vancouver BC, decided in the Carter case, to legalize euthanasia and assisted suicide. She decided that the current laws that prohibit assisted suicide infringe upon the Charter of Rights and Freedoms section that ensures that my life, liberty and security of the person is protected in Canadian law.

Smith not only got it wrong, her decision is the opposite of reality.

I have lived my life as a person with Cerebral Palsy. My experience as a person with a visible disability is that people do not treat me with equality value and acceptance.

As a child I experienced more than a dozen surgeries. These surgeries were incredibly difficult, but they gave me a chance to live.

I now have a scoliosis, a curvature of the spine, and I suffer with pain everyday. If suffering becomes a reason for euthanasia, then I will fear for my life.

I have been involved with opposing euthanasia since the death of Tracy Latimer in 1993. I am an advocate who opposes euthanasia because I love vulnerable people. Many people with disabilities, like Tracy Latimer are vulnerable and lack a voice. I have a voice.

Justice Smith stated in her decision that she found “no evidence of inordinate impact on vulnerable populations.”

Justice Smith must have been very selective in her research because she obviously missed the study from the Canadian Medical Association Journal (May 2010) that found that 32% of euthanasia deaths in the Flanders region of Belgium were without request or consent.

In Oregon the assisted suicide law contains a provision to safe-guard physicians who practice assisted suicide. The provision states that no person will be subject to any form of legal liability, whether civil or criminal if they act in good faith. In an ironic twist, assisted suicide physicians in Oregon are safer from liability if they cause a patients’ death than if they provide his or her medical treatment.

I am convinced that if euthanasia becomes accepted by society, that over a short period of time the attitudes will go from voluntary euthanasia for people who suffering to euthanasia to end the lives of the sufferer.

When euthanasia was legalized in the Netherlands, it was supposed to be a rare event to be resorted to only in the most unusual cases of intolerable suffering. The guidelines were designed specifically to keep euthanasia occurrences few and far between by establishing demanding conditions that had to be met at the risk of criminal prosecution.

Over time however, the conditions began to be interpreted loosely and they were ignored. Rather than being rare euthanasia has become a routine medical practice.

I have always thought that our greatest need was visibility, to be seen and heard. Although those are great needs there is a greater need and that is for people to listen to us.

We need a society that recognizes people with disabilities as having equality, value and acceptance, but we first need a society that recognizes the importance of protecting our right to live.

We live or die by the health of the physical environment which we struggle to conserve. Just as crucially, we are nourished by an ethical environment, the moral oxygen of our human world.

In the beautiful words of Dr. Margaret Cottle, a colleague of mine, we have been standing among ancient trees, an old-growth forest of noble principle. It has been growing organically for 2,400 years, since Hippocrates, a "delicate social ecology of mutual support and protection" which forbids the killing of a patient.

Carter v. Canada , the judge-decreed legalization of physician-assisted suicide and euthanasia in Canada, tries to take a chainsaw to that old-growth forest. Once it is gone, it will be gone forever. Plant some seedlings, but it will never be the same. Whether the prior Supreme Court of Canada ruling against this, and the clearly voted will of Parliament can be dismissed by a provincial court judge is now a topic of outrage.

What is notable and fascinating is how carefully this assault on our ancient and hard-won ethical environment has been planned. The door had to be opened, if only a crack, by using a story so compelling and a situation so extreme that ordinary people would be easily led by their compassion.

Carter v. Canada was at first only the tale of Kay Carter, an 88-year-old woman who was taken to Switzerland to die. The addition of likeable 64-year-old ALS victim, Gloria Taylor, four months after the lawsuit was launched, put meat on the bones of the case and has been a publicity triumph.

The general public thinks that the Carter ruling is only about appealing people like Gloria Taylor with desperate terminal illnesses. Her lawyer, Joe Arvay, claims publicly that the case is only about a tiny number of people in clearly hopeless situations. This is a useful tactic to get one foot in the door.

It would be nice to know the final plan, and fortunately Jocelyn Downie, the architect of the whole strategy, spelled it out in 2008:

There are many individuals whose lives are no longer worth living to them who have not been diagnosed with a terminal illness. They may be suffering greatly and permanently, but are not imminently dying. There is no principled basis for excluding them from assisted suicide.

Similarly, Arvay mused recently that his interest in the topic of euthanasia was sparked by seeing his mother "curled up in a fetal position for 5 years in a nursing home." Hard to give consent when you are demented. Maybe the need for competence and consent needs the re-thinking that is being urged in Washington state right now. Ominously, Arvay made this comment after delivering an invited lecture about assisted suicide and euthanasia at a Vancouver hospital for severely disabled children.

People who qualify to die under Carter would appear to not require physical disability (though it must be expected "soon"), and they must have a "serious" illness, which may be defined as "without remedy" if available care is not "acceptable to the person."

The suffering can be physical or psychological. ("Psychosocial" was disallowed in a burst of judicial restraint.) "Advanced weakened capacities." "No chance of improvement." The right number of hurdles to give some sport to the lawyers who will come after, but no problem jumping them if, say, you just stop taking your insulin: "Your honor, my client has had to thrust a sharpened tube of surgical steel into her person (see Section 7 of the Charter) four times a day for decades. How can the state force this agony to continue?"

Doctors have been free to abhor killing for 2400 years. It was a good run.

Thursday, June 21, 2012

An article written by Steve Doughty and published in the Daily Mail in the UK on June 19. The article reports on a research by Professor Patrick Pullicino that found that approximately 29% of all deaths in the UK are prematurely ended by use of the Liverpool Pathway, a plan that defines a patient as futile and then withdraws all treatment and care, including hydration and nutrition.

Professor Patrick Pullicino said doctors had turned the use of a controversial ‘death pathway’ into the equivalent of euthanasia of the elderly.

He claimed there was often a lack of clear evidence for initiating the Liverpool Care Pathway, a method of looking after terminally ill patients that is used in hospitals across the country.

It is designed to come into force when doctors believe it is impossible for a patient to recover and death is imminent.

It can include withdrawal of treatment – including the provision of water and nourishment by tube – and on average brings a patient to death in 33 hours.

The article estimates that approximately 130,000 people die prematurely or through euthanasia by omission related to the Liverpool Pathway. The article states:

There are around 450,000 deaths in Britain each year of people who are in hospital or under NHS care. Around 29 per cent – 130,000 – are of patients who were on the LCP.

Professor Pullicino claimed that far too often elderly patients who could live longer are placed on the LCP and it had now become an ‘assisted death pathway rather than a care pathway’.

Pullicino suggests that these deaths are often related to the need to control costs or a way of dealing with difficult patients. The article states:

He cited ‘pressure on beds and difficulty with nursing confused or difficult-to-manage elderly patients’ as factors.

Professor Pullicino revealed he had personally intervened to take a patient off the LCP who went on to be successfully treated.

He said this showed that claims they had hours or days left are ‘palpably false’. In the example he revealed a 71-year-old who was admitted to hospital suffering from pneumonia and epilepsy was put on the LCP by a covering doctor on a weekend shift.

Professor Pullicino said he had returned to work after a weekend to find the patient unresponsive and his family upset because they had not agreed to place him on the LCP.
‘I removed the patient from the LCP despite significant resistance,’ he said.

‘His seizures came under control and four weeks later he was discharged home to his family,’ he said.

The article then explains how the Liverpool Pathway can be equivalent to euthanasia

He (Pullicino) said: ‘The lack of evidence for initiating the Liverpool Care Pathway makes it an assisted death pathway rather than a care pathway.

‘Very likely many elderly patients who could live substantially longer are being killed by the LCP.

‘Patients are frequently put on the pathway without a proper analysis of their condition.

‘Predicting death in a time frame of three to four days, or even at any other specific time, is not possible scientifically.

This determination in the LCP leads to a self-fulfilling prophecy. The personal views of the physician or other medical team members of perceived quality of life or low likelihood of a good outcome are probably central in putting a patient on the LCP.’

He added: ‘If we accept the Liverpool Care Pathway we accept that euthanasia is part of the standard way of dying as it is now associated with 29 per cent of NHS deaths.’

Experts including Peter Millard, emeritus professor of geriatrics at the University of London, and Dr Peter Hargreaves, palliative care consultant at St Luke’s cancer centre in Guildford, Surrey, warned of ‘backdoor euthanasia’ and the risk that economic factors were being brought into the treatment of vulnerable patients.

The article concludes by quoting authorities who do not consider the Liverpool Pathway to be euthanasia. The article stated:

A Department of Health spokesman said: ‘The Liverpool Care Pathway is not euthanasia and we do not recognise these figures. The pathway is recommended by NICE and has overwhelming support from clinicians – at home and abroad – including the Royal College of Physicians.

‘A patient’s condition is monitored at least every four hours and, if a patient improves, they are taken off the Liverpool Care Pathway and given whatever treatments best suit their new needs.’

The Liverpool Pathway was originally established as guidelines to be used when the person was known to be dying and nearing death. Now that it is being routinely used for people who are not yet dying or elderly people who are difficult, it can be clearly stated that the Pathway is being abused.

Further to that, the Liverpool Pathway works by withdrawing all treatment and then using larger doses of morphine to ensure that the person does not suffer from the symptoms of dehydration. Clearly, the abuse of the Liverpool Pathway is a form of euthanasia by omission.

It is tragic when society becomes so cold and heartless that it simply ignores such rates of elder abuse.

It is tragic that people with terminal illnesses, like Gloria Taylor, have concluded that physician-assisted death is the only way to relieve their suffering. Excellent palliative care is available in this country, so no one needs to fear dying in excruciating pain or indignity.

It is astounding that we are courting physician-assisted dying, something the ancient Greeks rejected over 2,500 years ago. Before Hippocrates, a physician was either a healer or killer, depending on the intentions of the highest bidder for his services. Hippocrates and generations since have recognized that only physicians who pledge never to kill can be trusted with our care when we are most vulnerable.

As a physician, my concern is not theoretical. A few years ago I admitted to hospital an elderly woman with a fluctuating level of consciousness. When I ordered that she be given intravenous fluids, before a diagnosis had even been made, some of the nursing staff accused me of being overly aggressive and lacking in compassion. The woman eventually regained consciousness and, ironically, asked for water. Had euthanasia/physician assisted suicide been legal, fighting on her behalf would have been even more difficult.

It is ironic, too, in an age when the authority and integrity of every institution, from the church to government, is questioned, that proponents of physician-assisted dying are so eager to give physicians, (who can be just as fallible and corrupt as politicians, lawyers and clerics) the power to kill.

ALS often comes up when euthanasia and assisted suicide are discussed. The disease seems to be the poster child for the ‘right to die’ movement, and has been a part of major court cases including Gloria Taylor’s involvement in the recent Carter case and the 1993 Supreme Court case of Sue Rodriguez.

“Don’t you know about ALS/Lou Gehrig’s disease?” I’ve been asked by those who support assisted suicide. “How would you feel if it was your loved one dying of ALS? Do you know what the disease does?”

Amyotrophic lateral sclerosis? Yes, I do actually.

Several years ago my dad’s sister – my aunt and godmother – was diagnosed with the degenerative motor neuron disease that had also killed her grandmother many years before. Most patients only live between 3-5 years, but my aunt deteriorated quickly and we lost her on September 29, 2009 – only 13 months after diagnosis.

Even before the disease was officially diagnosed, she had to stop teaching due to problems with balance and standing. She called it ‘getting tippy’. By the time the disease had been officially diagnosed later that August, her mobility had been severely curtailed and the disease was already beginning to affect her speech. She warned my dad to let us kids know that if we picked up the phone and heard a drunk person on the other end, it was just their aunt.

Her approach to the disease mirrored her approach to life: blunt and practical. She quickly mobilized her husband and friends to rearrange the house for her so she had access to her scrapbooking materials and computer, and had a chair lift put in to help her get up and down the stairs. Legal matters were taken care of soon after the diagnosis as well. There was never any “Why me?” questions; she just hunkered down to handle life as it was presented to her. It was her way of doing things.

Despite living in a small farming community in Saskatchewan, she was able to get the assistance she needed to live at home for several months. Her condition worsened rapidly – much too rapidly – and despite the heroic efforts of my uncle and her home care providers, she had to be admitted to a palliative care unit in a nearby small town hospital early the next spring where she remained until her death in the fall. Her memorial service was held at the community hall to accommodate the crowd of friends, colleagues, family and former students from decades of teaching who came to pay their respects.

ALS is a ghastly disease. My aunt quickly lost her independence, and became reliant on others for the basics that we take for granted. She soon lost her ability to speak, and near the end of her life it was almost impossible for her to communicate. Through it all, her husband and the medical team continued to lavish their love and care on her to alleviate her pain and suffering as much as possible until she died. She was an individual with dignity, and was treated with dignity, despite all the indignities the disease subjected her to.

I hesitated before I began to write, I hesitated before I sent it to my dad to look over, and I hesitated before I posted it. I do not want anyone to misinterpret my meaning. I am not glorifying my aunt’s suffering nor am I trying to make her the new poster child of our movement. My aunt would not be anyone’s poster child, thanks very much. My point is this: I am aware that ALS has a very human face to it. But it is precisely that humanity, and the humanity of all the vulnerable, that puts me firmly against euthanasia and assisted suicide. I hate the fact that my aunt’s killer is being used as an excuse to allow killing. I shudder to think how the medical system would have treated my aunt if euthanasia and assisted suicide was a part of the Canadian health care system. Would they have seen her as a financial burden to the system? Would they have done a cost-benefit analysis on her life? Would her ability to function have come to define her value?

And while Gloria Taylor and Sue Rodriguez gave a face to the euthanasia and assisted suicide movement in Canada, their stories are not the only stories. Legalizing assisted suicide and euthanasia endangers our seniors, our friends and family with special needs and those suffering from diseases. These stories and our stories matter too.

I certainly wish my aunt hadn’t suffered or died, especially from such a horrific disease. I would like to see more research done on currently incurable diseases like ALS. I would like to see palliative care and pain relief improve. But creating a right to kill will not make that happen, nor is killing an acceptable way to ‘alleviate’ suffering. Instead, by allowing doctors to kill the sufferers, it only endangers the lives of all the vulnerable.

The following is an open letter that Kate Kelly sent to her Member of Parliament (MP). I decided to remove the name of the MP. Kate published an article on the death of her mother. The article titled: Mild stroke led to mother's forced dehydration. Thank you Kate, for sharing this with us.

Dear .... MP,

I am angry and upset about Justice Lynn Smith's decision in the Carter case, giving Gloria Taylor the "right" to assisted suicide/euthanasia.

This erroneous and presumptuous decision by Justice Smith is a guarantee of elder abuse unto death. We already have a problem with elder abuse in Canada. I witnessed this firsthand with my mother, when, after a mild stroke, the relative holding power of attorney decided my mother would have no treatment. I sat by my mother's bedside in a Nova Scotia nursing home, unable to do anything except hold her hand while she suffered for six days, before finally succumbing to dehydration and starvation. If Justice Smith's decision is allowed to stand, there will be no need for inconvenienced or greedy relatives to wait for even this questionable medical procedure of withholding treatment.

It appears that Justice Smith holds herself above the Government of Canada. She has given our elected representatives, such as yourself, a year to comply with her decision to allow people to "help" kill other Canadians. This is the right to commit homicide. The Federal Government of Canada decided many years ago that Canada would not kill convicted murderers, even if they want to die, but now Justice Smith had deemed that anyone in Canada can kill another person who allegedly asks to be killed.

MP ..., the "right" to kill someone is not a decision for a Provincial Court Justice to make. If Justice Smith's decision is upheld, Canada will be a place of supreme irony. We will have the distinction of protecting the lives of convicted murders, while allowing our vulnerable elders and others to be subject to human error or deliberate murder. We will also be, I believe, unique as a nation: Canada will be known as the country where a Provincial Judge has more power than the Federal Government.

Wednesday, June 20, 2012

What is strange about Smith's decision is that it's unclear what has changed since the Supreme Court of Canada rejected "assisted suicide" - really just state-sanctioned euthanasia - 19 years ago or, for that matter, when Parliament debated the issue two years ago and decided not to change the law.

Allowing doctors to kill patients nearing the end of their lives, even with their consent, cheapens the sanctity of life, no matter how horrible the disease a patient is suffering from.

Suicide is legal in Canada. Patients with ALS, who are at the forefront of these legal cases, already have the right to end their lives while they are capable if they don't wish to see their lives through to their natural conclusions.

In some of the very few countries where so-called "assisted suicide" has been allowed, euthanasia has soon followed.

Canada must retain its absolute prohibition on the killing of others if we are to continue to be a nation that values life.

What do you think? Email a brief comment, including your name and town to: provletters@theprovince.com.

Please write letters supporting the position of the Vancouver Province.

On Friday, June 15, 2012; Justice Lynn Smith made a disturbing decision in the Carter case in British Columbia. Justice Smith decided to strike down Canada’s law prohibiting assisted suicide. She legalized euthanasia ... a form of murder. She suspended her decision for one year to force Parliament to fulfill her demands and gave Gloria Taylor, who has ALS, a constitutional exemption to be killed by euthanasia or assisted suicide within the year.

We need you to help us:

urge Justice Minister Rob Nicholson to appeal the decision soon,

ask Justice Minister Nicholson to seek an injunction on the constitutional exemption that was given to Gloria Taylor, and

maintain a concerted effort in the media and within society by writing and responding to articles published in local and national media.

3. Canada prohibited capital punishment based on the possibility that the death of an innocent person may occur. Euthanasia and assisted suicide may result in the deaths of people without request or consent. Canada needs to continue prohibiting euthanasia and assisted suicide.

6. In April 2010, Parliament defeated Bill C-384, a bill that would have legalized euthanasia and assisted suicide by a vote of 228 to 59. Judges should respect the role of Parliament. Issues such as euthanasia and assisted suicide should be decided by Parliament.

Tuesday, June 19, 2012

Toronto Star columnist, Rosie DiManno published an article in the Toronto Star yesteday entitled: BC assisted suicide ruling an alarming interpretation of Charter. DiManno is a very interesting columnist and this article gets down to the core of how extreme the interpretation of the Charter by Justice Smith is, and how in real life experiences, euthanasia and assisted suicide results in abuse.

B.C.
Supreme Court Justice Lynn Smith thinks so, with an alarming landmark
interpretation of the Canadian Charter that would allow the extinguishing of
lives — sentient lives, not a non-person fetus in the womb. Section 15, which
guarantees equality, discriminates against people with severe disabilities,
Smith concluded in the decision released Friday, because those afflicted with
such limitations are unable to kill themselves unless somebody else provides a
helpful hand: injection, drugs, and why not a pillow over the mouth or a gentle
push off the ledge of a very tall building?

They
only take up space, after all, the acutely infirm and frail elderly, the forever
institutionalized in their long-term hospital beds and just-existing facilities;
such a burden on families and society. And some — like Gloria Taylor, the woman
contending with amyotrophic lateral sclerosis who was a plaintiff in the court
challenge — apparently see themselves as no more than the sum part of their
disabilities, unable to go on at some point, seeking an abetted release from
unbearable misery.

But
if that’s the image of self, how long before it might become an acceptable view
of others?

Open
that Pandora’s box of ethical imperatives — what we’ve always believed morally
wrong, murder most paramount — and absolute prohibition disappears. It doesn’t
take a Margaret Atwood or Kazuo Ishiguro to imagine a dystopian future where the
most vulnerable among us might be deemed expendable, with death a construct of
convenience.

Who
judges the quality of mercy in mercy killings? The Netherlands, first among
nations to slide from assisted suicide to legal euthanasia (in 2001), assured
that sedative dosages would be permitted only under rigorously monitored
conditions and narrowly to adult patients suffering “great pain with no hope of
relief’’ who had demonstrated “informed consent.’’ But Dutch hospitals have
admitted to euthanizing babies deemed to be in tremendous pain from incurable
disease or born with extreme deformities. There are those, including doctors,
who’ve advocated euthanasia for the severely mentally retarded — individuals who
clearly can’t form consent.

The
slippery slope isn’t an exaggeration; it’s human nature. That’s why absolute
prohibition is the standard in all but a handful of jurisdictions that Canada
might now join, should this B.C. court ruling either go unchallenged or find
concurrence at the Supreme Court of Canada, where the case is undoubtedly
headed.

Canada’s
top court also has before it the case of a 60-year-old man at Toronto’s
Sunnybrook Health Sciences Centre who has been in a purportedly vegetative and
irreversible state since a brain infection in 2010. Two doctors want to pull the
plug over the wishes of Hassan Rasouli’s wife and family. Indeed, the physicians
reject even the advisory framework of an existing provincial ethics committee
that considers such cases and, for that matter, the Health Care Consent Act of
Canada, arguing that ending someone’s life is “not treatment’’ as medically
understood.

The
Ontario Court of Appeal ruled against the doctors last year, ordering the
patient be kept alive, “with the assistance of life-support measures’’ until the
spouse agrees there is no further hope of recovery. Undaunted, the physicians
appealed to the Supreme Court. Clearly, they consider themselves the ultimate
arbiters of life and death. They’ve not been remotely chastened by developments
suggesting their original diagnosis was wrong anyway since Rasouli, according to
his family, has since been able to communicate by making a thumbs-up
gesture.

This
might all seem a long way from the B.C. case ruling on assisted suicide, but
it’s all of a piece: quality of life, who decides, and the lobotomizing refrain
of “dying with dignity,’’ as if any of us can be assured of that. Dying with
dignity is not a quantifiable entitlement and certainly can’t be enshrined in
law. There are no Charter guarantees protecting anybody from a life free of
sorrow. Some will die on the spot, felled by a heart attack. Others will endure
years of discomfort and anxiety, with all the “indignities’’ that are inflicted
by medical procedures and hospitalization.

In
her voluminous 140,000 word judgment, the B.C. judge also applied Section 7: the
right to life, liberty and security. If I understand it correctly, that would
include the liberty to commit suicide, which isn’t illegal in Canada. But Taylor
wouldn’t be able to commit suicide unassisted and that has not been legal, as
reinforced the last time the Supreme Court visited this issue 19 years ago, by a
slender 5-4 decision.

It
is radical inside-out rationalizing to turn right to life into right to death,
with a tortured reading of the Charter to bless approval of murder in some
circumstances. The judge may be an exceptionally wise person with a brilliant
legal mind, but she displayed a shockingly poor grasp of some basic premises
when challenging a government lawyer’s argument that life is sacrosanct and the
state cannot condone the taking of a life.

“But
(the state) sends young men off to war,’’ Justice Smith countered.

What’s
most regrettable in this case, the thing at the dark heart of the matter, is the
fundamental Right to Die ethos that a life overwhelmingly restricted, an
existence profoundly enfeebled, is a life not worth living. As if Gloria Taylor,
a mother and grandmother, will one day — as she presumably believes — when her
body is utterly stiffened and unresponsive to her commands, take no joy from the
sound of her grandchildren’s voices, or music, or a book read to her, or a movie
on TV, or the sun on her face. And if the state agrees that such a life can be
legally terminated, with a doctor assisting to hasten death, then how do we
reassure the many among us with severe handicaps, physical and mental, that
their lives have equal worth to the healthy and hale? It would be a legal and
moral contradiction. It would be a lie.

I
have no faith in the stipulation that Justice Smith appended: That an attending
physician and consulting psychiatrist each attest Gloria Taylor is competent and
her request for a physician-assisted death is shown to be voluntary, come the
day she decides to end her life. We have seen, in other jurisdictions, how such
a caution can be exploited and marginalized. Ours is an era of well-documented
elder abuse. Assisted suicide is an invitation to incalculable harm and
wrong-doing against the vulnerable.

The
judge immediately placed a 12-month suspension on her ruling, allowing
Parliament time to write new legislation or for the anticipated appeals by
provincial and federal governments to be filed. Taylor was given a legal
exemption so that she needn’t await any of that, can go ahead and kill herself,
if she chooses, with a doctor assisting who won’t be charged.

This
is no longer exclusively about her, however, because all Canadians have a stake
in what we can morally abide.

Parliament
has already spoken on assisted suicide. But in a country that lives and dies by
the Charter, politicians are trumped by judges. Frankly, I trust neither.

There
is one other legal remedy to the purported inequality that exists between those
capable of killing themselves and those who aren’t: Make suicide illegal for
everybody.

It
won’t make any difference to those who succeed. Those who survive can argue
their case before a judge. I’d like to see the first one to dare convict.

By Will Johnston, Chair, EPC - BCOn June 15, the British Columbia Supreme Court rendered a controversial judgment in the case of Carter vs. Canada, one that purports to create constitutional immunity for those who provide assistance to those seeking to kill themselves — a judgment that stands at odds with the Supreme Court of Canada’s Rodriguez ruling in 1993. The only saving grace is that doctors will not be scribbling lethal prescriptions any day soon: Current law will stand for at least a year (the sole exception being the plaintiff in this case, 64-year-old ALS patient Gloria Taylor). Let us hope that a higher court restores sanity to the issue before this 12-month period expires.

Justice Lynn Smith determined that the ban against assisted suicide serves to discriminate against the disabled — and therefore runs afoul of the equality provisions in section 15 of the Charter of Rights and Freedoms — because it prevents disabled people from getting the help they may need to kill themselves. But the Charter is meant to defend us against violations perpetrated by the state, not abet self-inflicted injuries or death.

Fighting suicide is a national policy. Suicide is strongly discouraged by all manner of health professionals, and some suicidal people are, by law, forcibly hospitalized for assessment and treatment. Yet, in the Carter decision, much is made of the idea that, since suicide is not actually illegal, it is unfair that the disabled who are unable to kill themselves are deprived of the help they need in doing so. Having measles is not against the law either, but most would call it an odd leap of logic to suggest that catching measles should be a constitutional right and that people too disabled to get themselves off to a measles epidemic must be given physician-assisted infection.

In Carter, the judge adopts what my experience tells me is a delusion: That a bright enough line can be drawn between those with identifiable physical ailments who want to die — candidates for “acceptable” assisted suicide — and those who are just depressed or psychotic.

Many of those who reject capital punishment on the chance that one innocent person might be executed have noticed that even the intense scrutiny of a murder trial can fail to get the facts right. Yet when it comes to assisted suicide and euthanasia, the Carter judgment claims that the risks associated with killing someone in an “unacceptable” state of depression or psychosis can be adequately managed.

The reality is that, in liberal foreign jurisdictions admired as models in the Carter decision, literally thousands of assisted suicides happen without the documented consent of those killed. Rules are ignored or become empty rituals. The Carter judgment appears to either misinterpret these deaths, or wave them off as acceptable collateral damage in the pursuit of personal choice and autonomy.

Most Canadians are easily confused by the distinction between refusing or withdrawing medical therapy, and intentional killing of the patient; and Carter contributes to this confusion. For instance, in one paragraph, a false parallel is drawn between a criminal failure to act, which leads to harm, and the doctor’s act of stepping aside when therapy is futile or refused. Common sense tells us that the disease kills the patient, not the doctor who was trying to help, and who is forbidden by law from imposing help when it is not wanted.

Overall, the Carter judgment provides 395 pages of reasons to justify a reckless social experiment that would be difficult to reverse, while dismissing the warnings that all is not well in the places that already have implemented such policies. Based on my 31 years of front-line medical experience, I urge Canadians to be very skeptical about going down this road.

National Post

Will Johnston is a Vancouver G.P., and chair of the Euthanasia Prevention Coalition of B.C.